Older women - the socio-economic realities

'An Ageing Society is evolving which for the most part is female'

Von Kasturi Sen

Policy makers throughout the world need to acknowledge that by the beginning of the twenty first century out of the 11 largest elderly populations in the world, eight will be in developing countries. Part of the process of compressed demographic transition means that the increase in elderly people in countries such as Thailand, Kenya and the Philippines will be up to 15 times higher than in the United Kingdom and Sweden in the period 1985 - 2020 ( Kalache 1996). With few exceptions, elderly people are the fastest growing component of the population in developing countries. Most of the world's elderly population ( 200 million of the current 356 million, or nearly two thirds) are already in the developing regions; by 2025 the proportion will increase to seventy five percent of the projected 650 million over 60 year olds (UN Population Projections 1997).e increase in Elderly population: Compressed transition 1950- 2025. Among this group longevity continues to favour women. Whilst there are considerable variations in life expectancy in the developing world in almost all countries of the world women outlive men.

Older women have received little attention from development agencies, policy makers and most of all from the women's movement, the traditional supporters of women's struggles. Somehow feminism's engagement with the multiple facets of women's lives seems to have a cut off point at menopause. Interest in mid life years has been minimal and in the later years almost non existent.

Older women continue to be excluded from research on health and well being in later life, despite their predominance in numbers and poor health status. Such issues are compounded by the lack of access to paid work a concentration among part time and low paid workers with little or no access to old age income security. This means that many women face poverty and insecurity in old age which reinforces poor health and dependence upon relatives or public services for care in later life.

Despite the advantage over men in longevity, women suffer from more chronic ailments such as arthiritis, osteoporosis as well as diabetes among other illnesses linked to life course hardships of repeat pregnancies, poor nutrition and the double burden of reproduction and production. Depression is more common among older women then men certainly in the developed world.

Need for Services

It is in the context of such demographic, social and health related changes that issues of vulnerability and of service need is raised. Whilst populations have always aged, the unique feature of the past 4- 5 decades has been the rapid pace of aging and especially so in the least developed regions of the world. This takes place at a time when there is much upheaval in the organization and function of public service provision. Despite the considerable numbers of older people, living independently in there own homes or within the extended family set up, the need for health and social care rises exponentially with age. Data on the prevalence of ill health and on the utilisation of health care in different regions of the world, highlights this point ( Heikkinen et al 1983 1993, Rao 1986, NCAER 1993, Ramos 1993,Guha Roy, Sen and Serra 1996 ). These studies also show the fact that the risk of losing functional ability (both cognitive and physical) is much greater at the oldest ages. In the United Kingdom for example, the most recent OPCS survey on disability (1986) reveals that 70 percent of adults with a disability were over 60 years of age compared to 25 percent of the general population (OPCS 1986). Similar evidence may be gleaned from the developing world where it is argued that a life time of arduous living may generate earlier functional ageing ( Kalache and Sen 1998). This means that despite the gains in longevity, chronic disabling conditions could occur as early as 50 years. Current studies in Brazil, India and the Middle East are indicative of this among particular groups of vulnerable elderly people ( Sen et al 1997, Sansui et al 1998) The evidence from most of the European studies highlight the fact that the need for support services either for personal care or long term care increases exponentially with age ( Heikinnen et al 1983 Challis 1996).

Developing countries- the dilemmas

In developing countries, one of the biggest dilemmas facing policy makers and service providers in recent years has been the export of welfare reforms, as part of a package of economic adjustment measures aimed at reducing public expenditure. This strategy imposed by donor agencies is being implemented despite the lack of evaluation of effectiveness in managing the needs of vulnerable groups (among others) in the countries where the policies originate. As a result there is growing concern about the implications for equity and for access to services as evidence begins to emerge suggesting that under the reforms health and social inequalities are increasing (Werner et al 1997, Sen and Koivusalo 1998).

There is by now sufficient evidence from Africa, Asia and Latin America to show that women have been hit especially hard by these monetarist measures. In India for example in the first years after the implementation of SAPs ( 1991), Nata Duvury ( 1995) reported that women's employment both in public and private sectors had been drastically affected by the policies of retrenchment with increased levels of insecurity although overall women fared better than males. But the more serious effect of the economic policies has been the increase in prices of basic commodities which appear to have affected the most vulnerable sections disproportionately, since they involved food security. In India, two thirds of women agricultural labourers for example lived below the poverty line in 1994. Female headed households constituted 35 per cent of poor households. The implication is a reduction in the consumption of staple foods, longer working hours and inevitably a worsening of health status.

Background to family support, social and health services- developing countries

Although in much of the developing world the family continues to play a central role in support of ageing relatives, social economic and demographic changes such as smaller family size, migration, unemployment, separation, divorce and widowhood mean that caring resources available in the past are under increasing train. Whilst thus far one can only assess the grim realities of the effects of macro economic policies at the level of the household and in particular for poor older women, it is essential to not to view older women solely as dependent and sick. The economic ( and unpaid) contributions made by older people generally and older women in particular towards the sustenance of extended households and often of communities as a whole cannot be under estimated. This has been documented elsewhere ( Sen 1995). It is the life long lack of recognition and the absence of payment in any form that leads to a situation of insecurity. The situation has been worsened by the demographic support ratios where by there are fewer children to support surviving elders.

While there are projections which suggest that most of the developing world will for the next several decades continue to have favorable demographic support ratios, owing to high fertility in the recent past, the continued survival of inter-generational families cannot be guaranteed as a long term norm (Kinsella 1996). This is owing to the emerging evidence that apart from changing demographic circumstances, the issue of 'quality of life' within family settings is of increasing significance. For example, extended families in the face of the growing pressures of work and other social change are transforming their outlook on duties and obligations towards elderly relatives. An increasing number of studies are beginning to report that older people often feel most neglected within the extended family, as increasing numbers of men and in particular women move towards paid employment. Duties and obligations are also altered under the influence of nuclear families and the rise in independent incomes unrelated to parental wealth. In some countries older people have found it increasingly difficult to cope with reduced standing in relation to decision making on family matters such as ideal family size and expenditure of monies for example. Intergenerational relations are beginning to alter throughout the world. In some places this raises conflict on issues of status, authority and power within patriarchal structures. In others it has led to neglect and abuse. Both affect the quality of life within families as units and for elderly persons in particular.

Since much policy is focused upon encouraging family support for elderly people, such reports raise an urgent need to complement demographic and epidemiological studies with socio cultural ones that will document issues of inter generation support, quality of life and financial need within family settings.

It is clear however that current economic policies which are to dismantle the fragile welfare provision ( of recent year) does not augur well for vulnerable groups. In fact the economic adjustment measure condemn millions of older people and older women in particular to be dependent upon uncertain and insecure family support as households, reel from the impacts of shrinking employment prospects, rising prices of the cost of essentials such as food, transport, & in particular healthcare.

The structural dislocation caused by such measures exacerbate the already harsh conditions of living faced by the majority of the world's population, many of whom face a daily struggle for survival. This contradiction is reinforces global inequalities. it further removes the notions of 'healthy ageing' and 'active life expectancy' that are being called for and debated in international circles from the lives of most people in the world. It is not that these are entirely meaningless concepts but given the disparities in consumption and expenditure between developed and developing countries, it further reinforce the policy divide between the rich and the poor world wide.

*Dr. Kasturi Sen is Senior Research Associate at the Dept. of Public Health of the University of Cambridge, UK.


Kalache A (1996) Ageing in Developing Countries. Principles and Practice of Geriatric Medicine 2nd edition Wiley and Sons, Chichester UK

United Nations (1997) Population Projections. UN Department for Economic and Social Information and Policy Analysis, Statistical Division. New York

Heikkinen E, Waters WE, and Brezenski, ZJ (1983) The Elderly in Eleven Countries: a socio-medical Survey, Copenhagen World Health Organisation Regional Office for Europe

Rao A.V (1990) Health Care for the Rural Aged. Indian Council for Medical Research, New Delhi. India

Ramos, L. (1992) Family Support for elderly people in Sao Paulo, Brazil.

Kendig,H Hashimoto A, Coppard,L.( 1992) Family Support for the Elderly: The International Experience. New York Oxford University Press

Guha Roy S, Sen K, Serra D, (1996) Demographic Transition and the Utilisation of Health care 1951-2000. Report submitted to the European Commission IC 18 CT 94 0021

Kalache, A and Sen K (1998) Ageing in Developing Countries, Principles and Practice of Geriatric Medicine 3rd Edition. John Wiley and Sons, Chicester UK

Challis, D (1996) community Care. Epidemiology in Old Age (eds) Ebrahim, S and Kalache a BMJ Books. London UK pp. 126-135

Werner D, Sanders D (1997). Questioning the Solution- The Politics of Primary Health Care and Child Survival. Health Wrights CA USA

Sen K, Koivusalo M (1998) Health Sector Reforms and Developing Countries- a critical overview. Int. Journal of Health Planning and Management 13 John Wiley and Sons, UK pp. 199-225

Duvurry, N (1995) Gender implications of New Economic policies & the Health Sector Social Scientist 256-59 pp. 40-55

M. Sansur et al (1998) Prevalence of Disability Among Palestinian Elderly ATTA, Jerusalem (1998)

Kinsella, K. ( 1996) Population Ageing in developing Countries. Meeting the Challenges of Population Ageing. INIA (International Institute of Ageing) Malta Proceedings of UN expert Group meeting 1995. edited by James Calleja. pp 23-46

The Office of Population and Census ( 1986) Disability at Older Ages. London. HMSO